Relapse of Juvenile Idiopathic Arthritis-Associated Uveitis after Discontinuation of Immunomodulatory Therapy

ABSTRACT

Purpose: To assess treatment outcomes in juvenile idiopathic arthritis (JIA)-associated uveitis and relapse rates upon discontinuation of immunomodulatory therapy (IMT). Methods: Medical records of patients with JIA-associated uveitis seen at the University of Illinois at Chicago and the F.I. Proctor Foundation uveitis clinics from September 14, 1988 to January 5, 2011 were reviewed. The main outcome was time to relapse after attempting to discontinue IMT.Results: Of 66 patients with JIA-associated uveitis, 51 (77%) received IMT as either sole or combination therapy. Of a total of 51, 41 (80%) patients achieved corticosteroid-sparing control. Attempts were made to discontinue treatment in 19/51 (37%) patients. Of a total of 19 patients, 13 (68%) attempting to discontinue IMT relapsed, with a median time to relapse of 288 days from the time of attempted taper/discontinuation (IQR: 108–338).Conclusions: Corticosteroid-sparing control of inflammation was achieved in the majority of patients; however, attempts to stop IMT were often unsuccessful. Close follow-up of patients after discontinuation of therapy is warranted.

Keywords:

• juvenile idiopathic arthritis-associated uveitis
• immunomodulatory therapy
• tumor necrosis factor-alpha inhibitors

DECLARATION OF INTEREST

NRA reports being a consultant for Abbvie and Santen. The authors report no other conflicts of interest related to this manuscript. The authors alone are responsible for the content and writing of the article. The authors have no proprietary interest in the subject of this manuscript.

FUNDING

This work was partly supported by a grant from the Doris Duke Charitable Foundation to UCSF to fund Clinical Research Fellow Dr Homayounfar. Dr Enanoria was supported for statistical consulting by That Man May See Foundation, UCSF. The UCSF Department of Ophthalmology is supported by National Eye Institute grant EY06190 and an unrestricted grant from the Research to Prevent Blindness Foundation. Dr Goldstein is supported by unrestricted grant from Research to Prevent Blindness. The sponsors or funding organizations had no role in the design or conduct of this research.

Additional information

Funding

This work was partly supported by a grant from the Doris Duke Charitable Foundation to UCSF to fund Clinical Research Fellow Dr Homayounfar. Dr Enanoria was supported for statistical consulting by That Man May See Foundation, UCSF. The UCSF Department of Ophthalmology is supported by National Eye Institute grant EY06190 and an unrestricted grant from the Research to Prevent Blindness Foundation. Dr Goldstein is supported by unrestricted grant from Research to Prevent Blindness. The sponsors or funding organizations had no role in the design or conduct of this research.